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l6e • ille, E`er F E PUBLIC WORKS REVIEW WORKSHEET <br />WASHINGTON <br />PROIECTADDRE55: 615 WARREN AVE <br />DESCRIPTION OF WORK: installatiandnewwMedine <br />] New Connection to main plus_ connections to building <br />] Attention <br />Repair <br />] Cap -off, country <br />] Rewnnection to stub <br />] Backwater Valve <br />] NOT REQUIRED <br />Explanation/Utility Permit III <br />RIG ITION SERVICE lead Including Cost Estimates) <br />] Meter Only, Size <br />] Water System Development Fee Total:$_ <br />] Buddhas, Prevention lOutame Building):[] DNA <br />] NOTREQUIRED <br />Permit N: 1.123081 <br />DOMESTIC WATER SE WCE:(Attach Calculated JOB Cost Est) <br />❑ New Concentrate Size _- []Per Cost Estimate <br />❑ Meter Only, Size -[]Per Cost Estimate <br />Water System Development Fee Total:$_ <br />❑ Sewer System Development Fee Taal:$_ <br />® Water Service Line (behind meter), Size 1-Inch <br />Bacardi Prevention (Outside Building):[] RPBA Q DNA <br />NOT REQUIRED <br />Explanation/Utility Permit N <br />FIRE SERVICE (A tach Cost EstimaM/ Requesljor Reference) <br />❑ New CunnectioneSize= [] Per Cost Estimate <br />❑ %" Detect Meter Only, Service Size <br />Backflow Prevention (Outside Building):[] DCDA <br />® NOT REQUIRED <br />Explanation/Utility Permit N <br />Explanation/Utility Permit N_ <br />ATER DEPARTMENT COST ESTIMATE NEEDE0.(IJyet, PW Reviewer to send exist estimate request to Water Department) <br />] Yes, Quantity See attached for reference. <br />Building): ❑ MA(jor Oomesthr service) ❑ RPBABut Domi servire) ❑DCDA Vor Fire secured) <br />] YES,L]See Attachedforwlculations/creel@ ]YES, Traffic Mitiga ran Total :$_ <br />To be added on PW To he added an ❑ See Attached for alculetions/credit <br />Quantity charged _SF Chani charged _SF ® NOT REQUIRED <br />QW is[] Ground only[] all surfaces CITY is[] Roof only[] all Ax s <br />$ S <br />)DRESS LETTER REQUIRED i (If Yes(rrew assigned address), print out Address Letter from TRAKLF Print Menu and include) <br />]YES —TYPE: O SUN ❑DUPLE% ❑ADU ❑ INFILL DWELLING []MULTI -FAMILY ❑COMMERCIAL <br />❑ See Attached Letter, 3 copies (Permit Tee& to issue one copy to contrary with permits, scan one ropy to Jeffery Marks) <br />❑ Digital copy attached to permit record Permitp_ <br />❑ Saved! to Address Folder in Development Tech File <br />] NOT REQUIRED <br />) YES —Type_ <br />] NOT REQUIRED <br />Reason: <br />❑ Stormwater PIECES Tab Completed! in TRAKT ❑ADATab Completedin TRAKT ❑Inspections Addedin TRAKR <br />] NOT REQUIRED <br />Worksheet completed By: %%tads i(Q(4s(IORt Date:0930 fl723 <br />Worksheet Federal By:%agoaya f3Fr)aN Date:OP30 P023 <br />